乌拉地尔与尼卡地平在腹腔镜下子宫肌瘤挖除术中预防垂体后叶素不良反应的效果比较

Efficacy of Urapidil and Nicardipine in preventing pituitrin-induced cardiovascular responses of patients undergoing

目的比较乌拉地尔与尼卡地平在腹腔镜下子宫肌瘤挖除术中应用垂体后叶素后诱发心血管不良反应的预防效果。方法选取90例腹腔镜下行子宫肌瘤挖除术的患者随机分为乌拉地尔组(W组)、尼卡地平组(N组)和对照组(C组),每组各30例。在子宫肌瘤挖除前,3组患者均于腹腔镜监视下肌瘤瘤体内注射垂体后叶素6U。W组患者在注射垂体后叶素前2min静脉注射乌拉地尔0.5mg/kg,N组患者注射垂体后叶素完毕后2min时静脉注射尼卡地平10μg/kg,C组患者注射垂体后叶素即刻静脉注射生理盐水5mL;维持术中双频谱脑电指数值在45～55。记录3组患者手术时间、子宫肌瘤个数及出血量,并于注射垂体后叶素前2min,注射即刻,注射后1、2、3、5、10、30 min(T_0～T_7共8个时点)记录患者的平均动脉压(MAP)与心率(HR)。结果 C组T_2时MAP较T0时降低,T_5～T_7时升高,差异均有统计学意义(P<0.05);W组、N组T_2时MAP较T_0时明显降低,差异有统计学意义(P<0.05),其余时刻与T_0时比较,差异无统计学意义(P>0.05);与C组比较,N组T_5～T_7时MAP较低,差异有统计学意义(P<0.05)。3组患者T_2时HR均较T_0时增快,与C组比较,N组HR在T_4～T_7时增快,与W组比较,N组HR在T_4～T_7时均快于W组,差异均有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤挖除术中应用乌拉地尔(0.5mg/kg)与尼卡地平(10μg/kg)均可预防瘤体注射垂体后叶素所引发的心血管不良反应,垂体后叶素注射后2min加用尼卡地平能获得相对更好的预防效果。

Objective To evaluate the preventive efficacy of Urapidil and Nicardipine in pituitrin-induced cardiovascular side effects for patients undergoing laparoscopic myomectomy.Methods A total of 90 cases,scheduled for elective laparoscopic myomectomy under general anesthesia,were randomly divided into three groups(n=30)including Urapidil group(group W),Nicardipine group(group N)and Control group(group C).Before myomectomy,pituitrin was injected into the myoma under laparoscopic surveillance in all three groups.Group W received intravenous urapidil 0.5 mg/kg at 2 minutes before pituitrin injection.In group N,nicardipine 10μg/kg was intravenously injected at 2 minutes after the injection of pituitrin.And in group C,pituitrin was injected immediately into normal saline by intravenous injection of 5 mL.The bispectral index value was 45-55 during maintenance operation.The operation time,the number of uterine fibroids and the amount of bleeding were recorded.The mean arterial pressure(MAP)and heart rate(HR)were recorded before 2 minutes of pituitrin injection,the moment of injection,1 minute,2 minutes,3 minutes,5 minutes,10 minutes and 30 minutes after pituitrin injection(T0-T7).Results In group C,MAP decreased at T2 compared to T0 and increased at T5-T7,with statistical significance(P<0.05).The MAP of group W and group N at T2 was significantly lower than that at T0,and the difference was statistically significant(P<0.05),and there was no significant difference between T0 and the rest of the time(P>0.05).Compared with group C,MAP in group N was lower at T5-T7,and the difference was statistically significant(P<0.05).HR increased faster at T2 than at T0 in all three groups.Compared with the C group,HR increased fast at T4-T7 in group N,and HR in group N was faster at T4-T7 than that in group W.The differences were statistically significant(P<0.05).Conclusion Laparoscopic application of urapidil(0.5 mg/kg)and nicardipine(10μg/kg)during hysteromyoma surgery can prevent adverse cardiovascular reactions caused by pituitrin injection into the tumors,and the addition of nicardipine in 2 minutes after the application of pituitrin can achieve a relatively better preventive effect.